All on Four

All on Four

What is the” All on Four” procedure?
This is a technique whereby we can place four implants in the upper or lower jaw to support a fixed bridge. This means that the patient can have implants placed and new teeth to chew with, the same day. This innovative procedure is not new, in fact it is over 30 years in the making. It was developed in Europe and has attained worldwide acceptance as the “standard of care” for implant supported bridgework. The refinement of dental implants and their components has allowed us to be able to bring this technology to our patients.


Who is a candidate for “All on Four”?
Essentially anyone who can safely undergo a dental implant, could be a candidate for the All on Four procedure. The ideal candidate for All on Four, is a person who has multiple failing teeth and they do not want a denture. We have seen our parents and grandparents struggle with dentures, and now we have options to avoid these problems! Dr. Michael and Dr. Stewart, with their background in surgery and years of experience, can evaluate you to determine if you would be a good candidate for the All on Four technique.
How does the “All on Four” procedure work?
We work closely with your referring dentist to coordinate a team approach to implant dentistry. We believe this offers optimal patient care. The first step in All on Four involves your dentist taking impressions of your mouth and certain records. From this a bridge will be fabricated for use at the time of surgery.
Our office will establish a surgical time once the bridge is ready, and we will have the dental lab present at your surgery. The actual surgical procedure takes about 1 ½ to 2 hours per arch. Once the implants are in place, the dental lab helps us by converting the bridge to the newly placed implants. This conversion process can also take several hours. As you see, if we do upper and lower jaw in one day, it can take the full day to complete the process.
The All on Four procedure is different than single tooth implants in that, loading of the implants is accomplished the same day. How is this possible? First, it requires four implants that are firmly anchored into the bone. We measure insertion torque of the implants when they are placed. Secondly, we utilize the bone of the anterior part of the jaw which is denser and usually has greater volume. Thirdly, the implant supported fixed bridge “’unifies” the four implants, spreading the load of chewing across all four implants. This allows the bridge to be placed on the implants the same day. Immediate function is a huge benefit of the All on Four procedure!
Most patients experience very little pain with the surgery and the postoperative process. In fact, they have less pain than they would normally have if they had chosen a removable type prosthesis. Our office will see you several times in the immediate postoperative period and coordinate visits with your dentist.
The implants must heal for 4 to 6 months and then your dentist removes the bridge that was placed at time of surgery, takes a new impression, replaces your bridge: so that you never go without teeth! A new permanent bridge is fabricated. Once this bridge is back from the lab, your dentist will schedule an appointment to seat the new bridge. Our patients report to us that the All on Four bridge “feels and chews” like natural teeth. Studies show that the all on four bridge gives patients a chewing efficiency nearly equal to that of natural teeth.


How long does “All on Four” bridgework last?
The procedure has been around long enough that we now have published 10+ year data that shows success rates for All on Four bridgework in excess of 98%. There is no other dental restorative procedure that has documented higher success rates than the All on Four procedure. As with any dental implant procedure, the All on Four is designed to be a permanent restoration, with the goal being, for you to have this implant bridge for the rest of your life.
What do I have to do to take care of my bridgework?
As with any dental implant, close attention to good oral hygiene is imperative for the longevity of the implant supported bridge. Our staff will review with you the necessary protocol for oral hygiene and maintenance of your prosthesis. We recommend an ultrasonic toothbrush, the use of chlorhexidine rinses, and a WaterPik type oral irrigation device for use in oral care. Additionally, flossing aides can be of benefit cleaning the implants. With good home care and regular professional follow-ups, you should be able to take excellent care of your implant supported bridge.


What does “All on Four” cost?
The total fee for all on four fixed bridgework normally runs about $24,000 an arch. This cost includes our surgery fee, a lab fee, and the restorative dentist fee. Each dentist chooses the amount they want to charge for their portion of this treatment plan, but this is a good estimate of the fee. While this may seem high, no less of an authority than Dr. Charles Babbush-a world-renowned implant expert, has stated, “When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.”
When you consider that in the era prior to All on Four, many patients had to undergo lengthy treatment plans with multiple tooth extraction, bone grafting and multiple implants, there is no doubt that the All on Four procedure is the best option for a patient who wants an implant supported fixed bridge.

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